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�. <br /> SAN JOAQUIN COU ' <br /> .Z� ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> Telephone: (209) 468-3424 Fax: (209)464-0138 Web:www.sgov.org/ehd i <br /> Liko'� <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: 4(l n -Tn S U t p S 1 Date: -7 <br /> Address: r' d 3 L ;$ 11 ✓� City. L G h r C Zip Code: 9S.7'r O <br /> Owner/Operator: Telephone: <br /> Program Element: Program Record: Inspection Type: w n e <br /> B180 Posted o Yes 0 Rermit Posted ❑Yes ❑! Re-Inspection on or After: <br /> ..............e:::.°::.:r..,.,_......;>..,..>.......r-r-:-i---=:.. '. <br /> AL-2 :�iR= mow <br /> tc <br /> c; <br /> e.s <br /> ar [ d C2 n Cjh or, o a 1" a G P rpu �+ <br /> se if e r w d locK 1i ds. prdv; A ► <br /> i <br /> f <br /> E <br /> I 'rug <br /> /1. .. oor ��f� `� C1 rP-coc ,'C u.la)015 7;7- <br /> N <br /> - -_---- __ -- -- _-- - __----.-- <br /> NJr t <br /> E <br /> � ...... <br /> 77MM, i7ll, m. �1i 1 :I!l,.F,. 1 } f %t ri asttllri <br /> Name: ,(� Hand Sink: t�F hlorine: ppm Heat: "F <br /> Wcn� s � 3 Sa c �r� <br /> Exp.Date: arewashing Sink: + a G 'F Ouat.Amm.: 2Cr ppm Other: 'F <br /> Received By!Titl <br /> EH Specialist: Phone: <br /> ime in: (?: l Time Out: G`5 Pageeof <br /> EHD 1624 (20°pg) 4131113 oC 1 FOOD PROGRAM OR CONTINUATION <br />